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Quarantine Stations At Ports of Entry Protecting The Publics Health Global Health Security: Public Health Interventions at Ports-of-Entry Center for Science.

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Presentation on theme: "Quarantine Stations At Ports of Entry Protecting The Publics Health Global Health Security: Public Health Interventions at Ports-of-Entry Center for Science."— Presentation transcript:

1 Quarantine Stations At Ports of Entry Protecting The Publics Health Global Health Security: Public Health Interventions at Ports-of-Entry Center for Science Technology & Security Policy American Association for the Advancement of Science & U.S. House of Representatives Committee on Homeland Security Georges C. Benjamin, MD, FACP,FACEP(E) Executive Director American Public Health Association July 23, 2007 At the Gates – Our Safety Depends On Eternal Vigilance

2 Historic Roots of Quarantine Biblical accounts of quarantine practices for persons with leprosy Epidemic plague in 14th C. Europe had profound impact on commerce 1485: Venice established 40-day (Lat. Quadragina) harbor detention, i.e., quarantine 1626: First Quarantine Station, Marseille The Quarantine Flag: Became the Q flag in the international maritime code of flag signals Quarantine in Colonial America (17 th C.) handled locally by each colony Massachusetts Bay Colony (Plague) Congress pass law allowing Feds to help states Yellow Fever Outbreak in Philadelphia: Governor declared cordon sanitaire

3 § Public Health Service Act, 1944 (42 USC §201) Basis for current federal quarantine authority Expanded maritime health service (55 stations and 500+ staff) Public Health Service hospitals Health screening of immigrants Illness assessment on vessels and aircraft

4 Quarantine Program, 1960s Board aircraft Review documents Monitor illness Quarantine stations to CDC, 1967 The war against infectious diseases has been won - WH Stewart, US Surgeon General, 1969

5 Functions of CDC Quarantine Station Respond to reports of illnesses on maritime vessels (cruise & cargo) & airplanes Emergency planning and preparedness Inspecting animal & human products posing threat to human health Monitoring health, and collecting, distributing and managing medical information of new immigrants, refugees & parolees

6 Functions of CDC Quarantine Stations Perform inspections of cargo & hand-carried items for potential vectors of human infectious diseases Distribute immunobiologics & investigational drugs Provide travelers with essential health information Respond to mass migration emergencies

7 Overarching Vision Washington Post U.S. to Triple Airport Quarantine Stations Health Program Aims to Prevent Infectious Diseases From Entering Country By Justin Gillis Washington Post Staff Writer Sunday, August 28, 2005; A16 The government plans to more than triple the number of quarantine stations at airports around the country an d hire scores of health officers as part of a broad plan to try to stop deadly infectious diseases from entering the United States. Ten new stations, at airports stretching from Alaska to Puerto Rico, are already open or nearing completion, and about 50 new health officers are undergoing training. The Centers for Disease Control and Prevention plans to build an additional seven stations as soon as it can get the money. Eight stations that have existed for years are gaining staff, so that when the plan is complete, the country will be blanketed by a network of 25 centers designed as a first-line of defense against a global disease pandemic. From Inspection to Strategic Leadership

8 Quarantine Core System & Network for U.S. Ports of Entry Air Transport Assoc. of America Network System Core Q Stations DGMQ HQ CDC CBP EMS Int. Org. for Migration State PHAs Hospitals Health-care providers Port officials USFWS USDA APHIS PH labs Air Transport Assoc. of America Foreign Gov'ts Courts Int. Council of Cruise Lines Canadian/ Mexican Border Authorities PHAC DHS FAA FBI State Dept. WHO News Media CSTE NACCHO ASTHO BIDS APHL DOT Media (general) Int. Civil Aviation Org. USCG FBI (local) LPHAs Overseas Panel Physicians USCG (local) FDA Source: IOM Report

9 The Central Challenge Ports of entry 52 seaports 41 airports 17 border stations 33 territory stations 41 U.S. consulates ~474 Plane Boat Boarder crossing People entering US Few million 425 million (CY2005) Number of Q Stations Over 55 stations 600 people 20 stations* 133 people Infectious DiseasesNo bioterrorism> 40 new ones since 1973 & bioterrorism 1953 (DHEW)2007 (HHS/CDC) *Was 8 stations & 40 people in 2005



12 Number of Persons Entering the United States, 2005 PortDaily Annual (millions) Air219,00080 Sea71,00026 Land874, Total1,164, Source: Securing Americas Borders at Ports of Entry; Office of Field Operations Strategic Plan FY ; Customs and Border Protection. Accessed at:

13 IOM Statement of Task Assess the role of federal quarantine stations in light of the emerging new environment for 21 st Century Look at the current role of quarantine stations and how they should evolve Evaluate the role of other agencies and organizations that work in collaboration with the CDCs DGMQ Assess role of state & local health departments Evaluate optimal locations for the quarantine stations Recommend the appropriate types of health professionals and necessary skill sets for staffing Address surge capacity to respond to public health emergencies

14 Seven Recommendations 1. Strategic Leadership 2. Harmonization of Authorities & functions 3. Infrastructure 4. Location of stations 5. Surge capacity 6. Research 7. Measuring performance

15 VT ME MA NY PA NH WV VA MD NJ RI CT AZ IN WI KY MI OH IA MN MO IL NE KS SD ND AL TN GA SC NC AR LA MS OK Atlanta Chicago Seattle WY ID WA AK OR MT NV UT NM CO East TX Miami FL No.CA So.CA Los Angeles San Francisco CDC Quarantine Stations & Jurisdictions*, 2007 HI Honolulu Washington, D.C. El Paso Houston Newark New York Boston GU San Juan Minneapolis Detroit Anchorage San Diego West TX PR CDC Station Philadelphia Dallas DE *Note: Regional jurisdictions have not been finalized

16 Quarantinable & Other Communicable Illness of Public Health Significance* Communicable diseases specified in Executive Orders of the President Recommendation of the Secretary HHS Revised on April 4, 2003 (Exec. Order 13295) Cholera or suspected cholera, diphtheria, infectious tuberculosis, plague, suspected smallpox, yellow fever, suspected viral hemorrhagic fevers, severe acute respiratory syndrome, novel influenza virus (pandemic potential) Public Health Significance* Malaria, typhoid, varicella, rabies, meningococcal, legionellosis, dengue, measles, polio, zoonotic poxvirus, pertussis, mumps, rubella, infectious diarrhea * Based on potential to a) cause significant morbidity and spread within the US; b) spread among passengers; c) be controlled by pharmaceutical and/or non-pharmaceutical interventions.

17 Disease Detection / Surveillance Pre-arrival Detectors passengers, crew, medical personnel, others Surveillance data or specific information from sources At time of arrival Customs and Border Protection, quarantine station staff, emergency responders, other airport partners, others Medical records, obvious illness, deaths, technology like fever screeners (Under evaluation), experience, risk based screens, others Post-arrival Off-site providers, state and local public health, others Post arrival illness or deaths Vary by Port and Conveyance; Air, Sea, Land

18 Surveillance at Ports of Entry, Conceptual Framework All illness at port of entry Quarantinable & Illness of public health significance Illness detected by surveillance

19 Underdeveloped Detection Opportunity Pre-departure evaluations State Department & HHS Thousands of individuals involved Review of any required medical immigration forms Best opportunity to detect disease Big gap here Significant occurrence of disease

20 Social Distancing Strategies Voluntary home curfew Suspend group activity Cancel public events Close public places Suspend public travel Restrict travel Snow days Non-essential workers off Work quarantine Cordon sanitaire Isolation Separation of infected persons Usually in a hospital setting (Other settings may be difficult) Quarantine Restriction of persons presumed exposed Community or individual level

21 Disease Control by Quarantine or Isolation Voluntary or legally compelled action Isolation Separation of infected persons Usually in a hospital setting (Other settings may be difficult) Quarantine Restriction of persons presumed exposed Usually at community or population level Designed to meet two objectives Facilitate early recognition of symptoms of a contagious disease, should they develop Reduce risk of transmission before progression to disease has been recognized Cordon Sanitaire (a.k.a. geographic quarantine) Sanitary barrier erected around an area Purpose is to control communicable disease

22 A collective action for the common good predicated on aiding individuals infected or exposed to infectious agents while protecting others from the dangers of inadvertent exposure Public goodCivil liberties Principles of Modern Quarantine

23 Key Questions before Decision to Quarantine Is there public health and medical justification? Infectious agent, communicability, risk of fatality Are implementation and maintenance of quarantine feasible? Define who is to be quarantined and for how long, and availability of resources Do potential benefits of quarantine outweigh adverse consequences? Determine health risks for those quarantined, consequences of quarantine disobedience, and effect on commerce JAMA, Dec 5,2001-vol 286, No 21:

24 Plan To Care For Sequestered Persons Food & Water Housing Hygiene & sanitation Social support systems Treatment & prophylaxis for disease Disease monitoring Dependent care Compensation & liability issues

25 Quarantine Stations At Ports of Entry Protecting The Publics Health Georges C. Benjamin, MD,FACP, FACEP(E) Executive Director American Public Health Association Protect, Prevent, Live Well

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